Sarcopenia in respiratory diseases

According to the current consensus published by the European Working Group in 2018, sarcopenia is considered not only as a geriatric syndrome caused by age-related degeneration of muscles, which are manifested by a decrease in strength, mass and functionality. A secondary form of pathology is also distinguished, which is a consequence of a wide range of diseases and conditions, which can develop regardless of age. Many respiratory diseases are currently known as possible causes of secondary sarcopenia, in which catabolic processes in muscle tissue were previously interpreted within the framework of systemic pathogenic effects. In 2021, a Japanese working group of researchers identified a separate phenotype – respiratory sarcopenia, which is associated with a decrease in strength, mass and functionality of the respiratory muscles, observed in a significant number of patients with various diseases, primarily of the respiratory tract, and with aging. The development of sarcopenia (both primary and secondary) has an important prognostic value, as a rule, it is associated with a severe course, a worse response to therapy, and unfavorable outcomes. The aim of the review was to accumulate and systematize the data of international open-access scientific publications since 2019 on sarcopenia and diagnostic approaches for its assessment in the most common respiratory diseases. The most relevant clinical and observational data are presented in the article. It was concluded that striated muscle damage in a wide range of respiratory tract diseases increases the risk of adverse patient outcomes, negatively affects the duration of hospitalization, and entails an increase in the costs of the healthcare system. Currently, a pressing problem in clinical medicine is the timely diagnosis of sarcopenia in conditions of comorbidity and the development of complex therapy programs, taking into account the involvement of muscle tissue and its significant role in long-term outcomes for patients.

1. Spruit MA., Singh SJ., Garvey C., ZuWallack R., Nici L., Rochester C., Hill K., Holland AE., Lareau SC., Man WD., … ATS/ERS Task Force on Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. Am. J. Respir. Crit. Care Med. 2013;188:e11–e40. doi: 10.1164/rccm.201309-1634ST

2. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., … Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. doi: 10.1093/ageing/afy169

3. Morley J.E., Kalantar-Zadeh K., Anker S.D. COVID-19: a major cause of cachexia and sarcopenia? J. Cachexia Sarcopenia Muscle. 2020;11(4):863–865. doi: 10.1002/jcsm.12589

4. Sergeeva V.A., Runikhina N.K. Pathogenetic and clinical relationships between chronic obstructive pulmonary disease, sarcopenia and frailty. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2024;(1):40–48. [In Russian]. doi: 10.37586/2686-8636-1-2024-40-48

5. He J., Li H., Yao J., Wang Y. Prevalence of sarcopenia in patients with COPD through different musculature measurements: An updated meta-analysis and meta-regression. Front. Nutr. 2023;10:1137371. doi: 10.3389/fnut.2023.1137371

6. Wu J.F., Jia J., Chen P., Wang X.F., Yang F.X., Liu Y., Ma Y.M., Jin J.W. Sarcopenia and its clinical correlation in elderly chronic obstructive pulmonary disease: a prospective cohort study. Eur. Rev. Med. Pharmacol. Sci. 2023;27(20):9762–9772. doi: 10.26355/eurrev_202310_34150

7. Yu Z., He J., Chen Y., Zhou Z., Wang L. Chronic obstructive pulmonary disease as a risk factor for sarcopenia: A systematic review and meta-analysis. PLoS. ONE. 2024;19(4):e0300730. doi: 10.1371/journal.pone.0300730

8. Nakano A., Ohkubo H., Taniguchi H., Kondoh Y., Matsuda T., Yagi M., Furukawa T., Kanemitsu Y., Niimi A. Early decrease in erector spinae muscle area and future risk of mortality in idiopathic pulmonary fibrosis. Sci. Rep. 2020;10(1):2312. doi: 10.1038/s41598-02059100-5

9. Fujita K., Ohkubo H., Nakano A., Takeda N., Fukumitsu K., Fukuda S., Kanemitsu Y., Uemura T., Tajiri T., Maeno K., … Niimi A. Serum creatinine/cystatin C ratio is a surrogate marker for sarcopenia in patients with idiopathic pulmonary fibrosis. BMC Pulm. Med. 2022;22(1):203. doi: 10.1186/s12890-022-02000-3

10. Faverio P., Fumagalli A., Conti S., Madotto F., Bini F., Harari S., Mondoni M., Oggionni T., Barisione E., Ceruti P., … Luppi F. Sarcopenia in idiopathic pulmonary fibrosis: a prospective study exploring prevalence, associated factors and diagnostic approach. Respir. Res. 2022;23(1):228. doi: 10.1186/s12931-02202159-7

11. Zhao L., Huang S., Jing F., Yu T.T., Wei Z., Chen X. Pneumonia risk prediction in patients with acute alcohol withdrawal syndrome through evaluation of sarcopenia index as a prognostic factor. BMC Geriatr. 2023;23(1):84. doi: 10.1186/s12877-023-03792-7

12. Zhang M., Xiong Y., Chen M., Xu D., Xu K., Tian W. Psoas muscle mass index and peak expiratory flow as measures of sarcopenia: relation to outcomes of elderly patients with resectable esophageal cancer. Front. Oncol. 2023;13:1303877. doi: 10.3389/fonc.2023.1303877

13. Okazaki T., Suzukamo Y., Miyatake M., Komatsu R., Yaekashiwa M., Nihei M., Izumi S., Ebihara T. Respiratory muscle weakness as a risk factor for pneumonia in older people. Gerontology. 2021;67(5):581–590. doi: 10.1159/000514007

14. Nagano A., Wakabayashi H., Maeda K., Kokura Y., Miyazaki S., Mori T., Fujiwara D. Respiratory sarcopenia and sarcopenic respiratory disability: concepts, diagnosis, and treatment. J. Nutr. Health Aging. 2021;25(4):507–515. doi: 10.1007/s12603-021-1587-5

15. Sato S., Miyazaki S., Tamaki A., Yoshimura Y., Arai H., Fujiwara D., Katsura H., Kawagoshi A., Kozu R., Maeda K., … Wakabayashi H. Respiratory sarcopenia: A position paper by four professional organizations. Geriatr. Gerontol. Int. 2023;23(1):5–15. doi: 10.1111/ggi.14519

16. Sergeeva V.A., Runikhina N.K. Respiratory sarcopenia: aspects of pathogenesis, approaches to diagnosis. Pulmonologiya = Pulmonology. 2024;34(6):869–878 [In Russian]. doi: 10.18093/0869-0189-2024-4271

17. Jeon Y.K., Shin M.J., Kim M.H., Mok J.H.,тKim S.S., Kim B.H., Kim S.J., Kim Y.K., Chang J.H., Shin Y.B., Kim I.J. Low pulmonary function is related with a high risk of sarcopenia in community-dwelling older adults: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011. Osteoporos. Int. 2015;26(10):2423–2429. doi: 10.1007/s00198-015-3152-8

18. Son D.H., Yoo J.W., Cho M.R., Lee Y.J. Relationship between handgrip strength and pulmonary function in apparently healthy older women. J. Am. Geriatr. Soc. 2018;66(7):1367–1371. doi: 10.1111/jgs.15410

19. Choe E.K., Lee Y., Kang H.Y., Choi S.H., Kim J.S. Association between CT-measured abdominal skeletal muscle mass and pulmonary function. J. Clin. Med. 2019;8(5):667. doi: 10.3390/jcm8050667

20. Trevisan C., Rizzuto D., Maggi S., Sergi G., Welmer A.K., Vetrano D.L. Cross-sectional and longitudinal associations between peak expiratory flow and frailty in older adults. J. Clin. Med.. 2019; 8(11):1901. doi: 10.3390/jcm8111901

21. Kera T., Kawai H., Ejiri M., Ito K., Hirano H., Fujiwara Y., Ihara K., Obuchi S. Comparison of characteristics of definition criteria for respiratory sarcopeniathe otassya study. Int. J. Environ. Res. Public Health. 2022;19(14):8542. doi: 10.3390/ijerph19148542

22. Ma K., Huang F., Qiao R., Miao L. Pathogenesis of sarcopenia in chronic obstructive pulmonary disease. Front. Physiol. 2022;13:850964. doi: 10.3389/fphys.2022.850964

23. Mollica M., Aronne L., Paoli G., Flora M., Mazzeo G., Tartaglione S., Polito R., Tranfa C., Ceparano M., Komici K., Mazzarella G., Iadevaia C. Elderly with COPD: comoborbitidies and systemic consequences. J. Gerontol. and Geriatr. 2021;69:32–44. doi: 10.36150/2499-6564-434

24. Alizadeh Pahlavani H. Exercise therapy for people with sarcopenic obesity: myokines and adipokines as effective actors. Front. Endocrinol. (Lausanne). 2022;13:811751. doi: 10.3389/fendo.2022.811751

25. O’Connor D.B., Thayer J.F., Vedhara K. Stress and health: a review of psychobiological processes. Annu. Rev. Psychol. 2021;72:663–688. doi: 10.1146/annurev-psych-062520-122331

26. Sinam I.S., Chanda D., Thoudam T., Kim M.J., Kim B.G., Kang H.J., Lee J.Y., Baek S.H., Kim S.Y., Shim B.J., … Lee I.K. Pyruvate dehydrogenase kinase 4 promotes ubiquitin-proteasome system-dependent muscle atrophy. J. Cachexia Sarcopenia Muscle. 2022;13(6):3122–3136. doi: 10.1002/jcsm.13100

27. Wang Z., Zhou X., Deng M., Yin Y., Li Y., Zhang Q., Bian Y., Miao J., Li J., Hou G. Clinical impacts of sarcopenic obesity on chronic obstructive pulmonary disease: a cross-sectional study. BMC Pulm. Med. 2023;23(1):394. doi: 10.1186/s12890-023-027022

28. Joppa P., Tkacova R., Franssen F.M., Hanson C., Rennard S.I., Silverman E.K., McDonald M.L., Calverley P.M., Tal-Singer R., Spruit M.A., … Rutten E.P. Sarcopenic obesity, functional outcomes, and systemic inflammation in patients with chronic obstructive pulmonary disease. J. Am. Med. Dir. Assoc. 2016;17(8):712–718. doi: 10.1016/j.jamda.2016.03.020

29. Sergeeva V.A., Bulgakova S.V., Runikhina N.K., Ponedelnikova E.V. Bendopnea in geriatric patients with different body composition parameters: an observational study. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2025;(1):66–74. doi: 10.37586/2686-8636-1-2025-66-74

30. Avdeev S.N., Aisanov Z.R., Belevskiy A.S., Ilkovich M.M., Kogan E.A., Merzhoeva Z.M., Petrov D.V., Samsonova M.V., Terpigorev S.A., Trushenko N.V., … Shmelev E.I. Federal clinical guidelines on diagnosis and treatment of idiopathic pulmonary fibrosis. Pulmonologiya = Pulmonology. 2022;32(3):475–495 [In Russian]. doi: 10.18093/0869-0189-2022-32-3-473-495

31. Murtha L.A., Morten M., Schuliga M.J., Mabotuwana N.S., Hardy S.A., Waters D.W., Burgess J.K., Ngo D.T., Sverdlov A.L., Knight D.A., Boyle A.J. The role of pathological aging in cardiac and pulmonary fibrosis. Aging Dis. 2019;10(2):419–428. doi: 10.14336/AD.2018.0601

32. Hanada M., Sakamoto N., Ishimoto H., Kido T., Miyamura T., Oikawa M., Nagura H., Takeuchi R., Kawazoe Y., Sato S., … Kozu R. A comparative study of the sarcopenia screening in older patients with interstitial lung disease. BMC Pulm. Med. 2022;22(1):45. doi: 10.1186/s12890-022-01840-3

33. Sheehy R., McCormack S., Fermoyle C., Corte T. Sarcopenia in interstitial lung disease. Eur. Respir. Rev. 2024;33(174):240126. doi: 10.1183/16000617.0126-2024

34. Anjanappa M., Corden M., Green A., Roberts D., Hoskin P., McWilliam A., Choudhury A. Sarcopenia in cancer: Risking more than muscle loss. Tech. Innov. Patient Support Radiat. Oncol. 2020;16:50–57. doi: 10.1016/j.tipsro.2020.10.001

35. Fujita K., Ohkubo H., Nakano A., Mori Y., Fukumitsu K., Fukuda S., Kanemitsu Y., Uemura T., Tajiri T., Maeno K., … Niimi A. Frequency and impact on clinical outcomes of sarcopenia in patients with idiopathic pulmonary fibrosis. Chron. Respir. Dis. 2022;19:14799731221117298. doi: 10.1177/14799731221117298

36. Moon S.W., Choi J.S., Lee S.H., Jung K.S., Jung J.Y., Kang Y.A., Park M.S., Kim Y.S., Chang J., Kim S.Y. Thoracic skeletal muscle quantification: low muscle mass is related with worse prognosis in idiopathic pulmonary fibrosis patients. Respir. Res. 2019;20(1):35. doi: 10.1186/s12931-019-1001-6

37. Fujikawa T., Kondo S., Saito T., Inoue T., Otake K., Misu S., Sakai H., Ono R., Tomioka H. Impact of sarcopenia defined by carina-level skeletal muscle mass on the long-term prognosis of patients with idiopathic pulmonary fibrosis. Respir. Med. Res. 2022;82:100965. doi: 10.1016/j.resmer.2022.100965

38. Cheng X., Jiang S., Pan B., Xie W., Meng J. Ectopic and visceral fat deposition in aging, obesity, and idiopathic pulmonary fibrosis: an interconnected role. Lipids Health Dis. 2023;22(1):201. doi: 10.1186/s12944-023-01964-3

39. Lee S.E., Park J.H., Kim K.A., Kang Y.S., Choi H.S. Association between sarcopenic obesity and pulmonary function in Korean Elderly: Results from the Korean National Health and Nutrition Examination Survey. Calcif. Tissue Int. 2020;106(2):124–130. doi: 10.1007/s00223-019-00623-z

40. Fujishima I., Fujiu-Kurachi M., Arai H., Hyodo M., Kagaya H., Maeda K., Mori T., Nishioka S., Oshima F., Ogawa S., … Yoshimura Y. Sarcopenia and dysphagia: Position paper by four professional organizations. Geriatr. Gerontol. Int. 2019;19(2):91–97. doi: 10.1111/ggi.13591

41. Ebihara S., Sekiya H., Miyagi M., Ebihara T., Okazaki T. Dysphagia, dystussia, and aspiration pneumonia in elderly people. J. Thorac. Dis. 2016;8(3):632– 639. doi: 10.21037/jtd.2016.02.60

42. Buchman A.S., Boyle P.A., Wilson R.S., Gu L., Bienias J.L., Bennett D.A. Pulmonary function, muscle strength and mortality in old age. Mech. Ageing Dev. 2008;129(11):625–631. doi: 10.1016/j.mad.2008.07.003

43. Okazaki T., Ebihara S., Mori T., Izumi S., Ebihara T. Association between sarcopenia and pneumonia in older people. Geriatr. Gerontol. Int. 2020;20(1):7–13. doi: 10.1111/ggi.13839

44. Huang S., Zhu T., Chen M., Lei X., Li Q., Tan Y., Chen X. Association between the severity of sarcopenia and pneumonia in patients with stable schizophrenia: a prospective study. J. Nutr. Health Aging. 2022;26(8):799–805. doi: 10.1007/s12603-022-1830-8

45. Shu X., Song Q., Huang X., Tang T., Huang L., Zhao Y., Lin T., Xu P., Yu P., Yue J. Sarcopenia and risk of postoperative pneumonia: a systematic review and meta-analysis. J. Nutr. Health Aging. 2025;29(3):100457. doi: 10.1016/j.jnha.2024.100457

46. Ali A.M., Kunugi H. Screening for sarcopenia (physical frailty) in the COVID-19 Era. Int. J. Endocrinol. 2021;2021:5563960. doi: 10.1155/2021/5563960